Change in Activity of Palliative Care Services during the Covid-19 Pandemic: A Multinational Survey (CovPall).

Katherine E Sleeman,Nancy Preston,Rachel L Cripps,Adejoke O Oluyase,Irene J Higginson,Lesley Dunleavy,Matthew Maddocks,Fliss E.M Murtagh,Catherine Walshe,Lorna K Fraser,Sabrina Bajwah,Mevhibe B Hocaoglu,Andy Bradshaw

doi:10.1089/jpm.2021.0315

Abstract

Objectives:To identify factors associated with palliative care services being busier during Covid-19.Methods:Cross-sectional online survey of UK palliative care services (April to July 2020) (CovPall). Ethical approval was received from King's College London Research Ethics committee (LRS-19/20-18541). The primary outcome was change in busyness (five-point ordinal scale). Ordinal logistic regression investigated factors associated with the primary outcome.Results:Of 277 responses, 71 (26%) reported being a lot more busy, 62 (22%) slightly more, 53 (19%) about the same, 50 (18%) slightly less, and 28 (10%) much less busy. Increased business was associated with homecare services (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.15–3.25), nursing care at home (OR 3.24, 95% CI 1.70–6.19), publicly managed services (OR 2.20, 95% CI 1.11–4.34), Covid-19 cases (OR 1.01, 95% CI 1.00–1.01), and staff shortages (OR 2.71, 95% CI 1.64–4.48).Conclusion:Services providing community care, and publicly managed services, may have been better able to respond to escalating needs during Covid-19. This has potential implications for both service delivery and funding models.

Highlights

The Covid-19 pandemic gave rise to a rapid increase in the level of need for palliative care.[1,2,3] In parallel, there were changes in patient and family priorities, with people who might otherwise have been admitted to a hospice choosing to be cared for at home due to fear of infection and visiting restrictions.[4,5] In response, many hospice and palliative care services rapidly innovated, reconfiguring services, increasing community outreach, and adopting new technology for communication with patients, families, and professionals.[6]During the first months of the pandemic, some hospice and palliative care services reported being more busy, while others reported being less busy than before.[7]
We excluded the number of suspected cases of Covid-19 as it correlated closely with confirmed cases
During the Covid-19 pandemic, there were a shift in patient and family preferences as visiting restrictions and fear of infection meant many people preferred to remain at home rather than go to hospitals or to inpatient hospice units,[4] and deaths in inpatient hospices fell, while home deaths

Summary

Introduction

During the first months of the pandemic, some hospice and palliative care services reported being more busy, while others reported being less busy than before.[7] We know little about which services experienced increased activity levels, and which experienced reduced activity levels. Understanding whether services that reported becoming more (or less) busy share certain characteristics could help identify strategies and/ or structures to maximize the contribution of hospice and palliative care services to the wider health and social care system, during current and future pandemics. The aim was to identify factors associated with palliative care and hospice services being busier during the Covid-19 pandemic

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Discussion

Conclusion